Organization
ATHLETICO LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANA GRANADOS (CREDENTIALING MANAGER)
(630) 575-1980
Entity
Organization
Contact information
Practice address
655 KENMOOR AVE SE STE 103, GRAND RAPIDS, MI 49546-8622
(616) 315-0100
(614) 410-7790
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/20/2022
Last updated
10/20/2022
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